Does PCI convert “A positive stress test” into “Negative” in all patients with CAD ?

* Logic would tell us myocardial revascularisation should correct stress induced ischemia and it should disappear promptly . This does not happen in all cases real world ! That is why medicine is different from mathematical science .

Some of the reasons for persistence of stress positivity even after an apparently successful PCI are . . .

Incomplete correction of ischemia. (Ideally to be referred as failed PCI )

Many diabetic patients may continue to show stress ischemia due to small vessel disease.

A patient with syndrome X characters can have incidental epicardial lesion as well . In such a patient EST will always be positive .

* Optimal time to do EST for assessing the efficacy of PCI/CABG is not established .Six months may be the reasonable point .If done within 2- 3 months it may end up in embarrassment for the Interventionist . (So only it is kept at 6 months , this also help us greatly as we can always blame it on poor life style control and progression of the disease !)

** No reference for this , a personal observation .We know Q leads following MI , will show ST elevation during stress test especially if the segments are dyskinetic . In leads diagonally opposite to q leads , ST depression is observed . This may not be a evidence for true ischemia . It probably represents ST drag due to mechanical stretch .